Host modulation therapeutics in periodontics: role as an adjunctive periodontal therapy

Host Modulation Therapy [HMT] is a treatment concept that reduces tissue destruction and stabilizes or even regenerates inflammatory tissue by modifying host response factors. It has been used for treating osteoporosis and arthritis for several decades. However, its use in dentistry has only been recently reported. The objective of this article is to present a review of the various literatures available on HMT and also its role as adjunct therapy in periodontics. For identifying studies for this review, a PUBMED search was carried out in 2013 for all articles published till December 2012. The search was restricted to English language publications only. Longitudinal prospective and retrospective studies were included in the search. The key words used were: Host Modulation Therapy; Sub antimicrobial dose doxycycline and Non-Surgical Periodontal Therapy. The main outcomes sought were host modulation therapeutics in periodontics. Exclusion criteria included cross sectional studies, short case series as well as studies with short follow-up periods. There is a paucity of literature on HMT in periodontics although the only drug approved by United States Food and Drug Administration [FDA] is a subantimicrobial dose of doxycycline [SDD] with highly predictable results as a host modulating agent in periodontal diseases and also an effective adjunctive therapy in various diseases of periodontium. However, more randomized controlled trials are needed to obtain clinical guidelines on the usage of other host modulating agents as adjunct as well as definite therapy for periodontal diseases. SDD is an effective adjunct therapy when used in dosage of 20mg twice daily for minimum 3 months duration in various periodontal diseases with predictable clinical outcomes. It is also recommended that future clinical research on anti cytokine drugs, chemically modified tetracycline and other HMT agents should be conducted so that new drugs are available with highly predictable results

Hepatic trauma and associated injuries- experience in a tertiary care hospital

The objective of this study was to analyze and document the presentation of liver trauma and associated injuries. Present study was conducted from January 2010 to December 2011 at Jinnah Postgraduate Center, Karachi, Pakistan. Oral and written consent was obtained from the participants before the start of the study. Inclusion criteria included all patients, aged more than 13 years with hepatic trauma admitted in the wards. The patients with co existing chronic hepatic diseases were excluded. This study comprised of 61 participants, among those [95%] were males and [5%] were females. The mean age of the participants was 31.4. The mean age for female participants was 28.3 while for male was 31.6. Amongst the patients with hepatic trauma, 67.2% had road traffic accidents [RTA] as the cause of their liver injury followed by firearm injury in 19.7%of the cases, physical assault in 9.8% and stab wound in 3.3% of the patients. Investigations done on the patients were ultrasound and C.T scan. In this study 60.7% patients were diagnosed on abdominal ultrasound and 14.8% were found to have hepatic trauma on the abdominal C.T scan. In all the patients with hepatic injury 50.8% had associated injuries. The most common associated injury was chest complications which was present in 10 [16.4%, C.I: 3.7-39.7] patients followed by gut perforation which was present in 11.4% patients. Other common injuries included forearm fracture which was present in 09.8%patients, spleen injury was found in 8.1% and diaphragm injury in 4.9% patients. In Pakistan Road traffic accident is one of the most frequent causes of Hepatic injury and middle aged men are at the highest risk of hepatic trauma

Patient satisfaction levels in surgical ward of a tertiary care hospital in Karachi

Patient satisfaction is a good yardstick to measure care giver's success. Patient satisfaction is one of the pertinent objectives of health care system. Since doctor-patient relationship is most crucial and decisive in patients' perception of care and satisfaction, from this survey, we explore various aspects of care received from doctors that determine the overall satisfaction level of patients. The objective of this study was to find out the level of patients satisfaction with various aspects of care provided by doctors in surgical ward in a tertiary care hospital in Karachi. Data was collected from a convenient sample of 174 patients, at the time of discharge from the health facility, who were admitted to surgical ward of Ziauddin Hospital, KDLB campus. Study design was cross sectional. Data collection was done from August till September 2013. Questionnaire was developed after literature review. Patient satisfaction was recorded using the 5 point Likert scale. Data analysis was done on SPSS version 19. Overall there were 57.5% males and 42.5% females participants. 41% of the participants were between 35-44 years of age. 42.5% were educated up to primary level, while 19.5% were not educated at all. Overall satisfaction level was 100%, with 66.7% noted as very satisfying while 33.3% as satisfying. Doctors' politeness, availability, provision of post operative care and discharge counseling were strong determinants of overall satisfaction. Explanation of medicines and patients' participation in their illness discussion were areas of uncertainty and dissatisfaction. Doctors' polite attitude, consultation and availability are vital to patient satisfaction. Areas that need more attention are, seeking patient views in their illness discussion, explaining them prescription drugs and lab investigations

Orally and sexually transmitted gonorrhea

Gonorrhea can be transmitted by oral sex and is known as pharyngeal gonorrhea and appears as pharyngitis. Patients with symptomatic gonorrhea infection or other STDs are commonly seen in outpatient departments. Majority of them seek treatment without having adequate understanding regarding the nature of their condition. It is important for a healthy community that the members have information regarding STDs, their spread and preventive measure. The study was conducted during the time period of six months extending from August 2013-January 2014. The data was collected from four tertiary care hospital after obtaining oral and written consent. Patients attending Urology outpatient department with a history of STD were included in the study. Overall 410 patients participated in the study with a response rate of 82%. 315[76.8%] males and 95[23.2%] female participants. 37.8% of females and 36.5 of males with total 36.8% of participants had knowledge that PID is a complication of Gonorrhea. In total 16.3% of the participants knew the correct mode of transmission of Gonorrhea with 22% females and 14.6% males with Odd ratio F/M 1.5. Regarding the best preventive measure for STD, 60.7% considers avoiding multiple sexual partners and engage in spousal relationship [53.7 and 62.8% of females and male respectively, Odds ratio F/M 0.85] is the best way followed by using condoms [20.7% of total participant with an odds F/M of 1.54]. The knowledge in patients regarding Gonorrhea is scant hence it is essential to counter educational needs of the population regarding STD in effective and timely manner

Urinary incontinence- patient's physical, mental and oral health analysis

Urinary incontinence can be distressful and may affect the quality of life to a great extent. Common types of UI are stress incontinence, urge incontinence and mixed incontinence. UI is more prevalent in older people and more frequently diagnosed in females than males. Efforts are made to investigate the primary disorder which causes incontinence, as UI is mostly secondary to an underlying medical condition. This study included patients diagnosed with UI and was conducted during one year period extending from February 2013 to January 2014. The data also constituted of a self-administered questionnaire to access the patient's knowledge regarding their disease. Ethical consent was obtained from the hospital where data were collected and oral and written consents were taken from all the participants prior to their participation. The study included 332 patients with a response rate of 73.7%. Overall, 254 males and 278 females participated. 64.9% of the male participants had urge incontinence followed by 26.6% having stress incontinence, while only 8.44% of the males were diagnosed with mixed incontinence. In females 77.2% had stress incontinence followed by urge incontinence [15.1%] and only 7.3% had Mixed urinary incontinence. 24% of males and 44.3% of females believed that pelvic exercises can prevent or treat UI. 34.6% of the total participants [40% females,27.9% males] had an understanding that weak anatomy contributes to the development of UI. Stress incontinence is more common in women, while the dominant type in men is urge continence. All patients, especially pregnant women should be provided information regarding UI in order to efficiently cope up with the condition if encountered

Oral aspects of chronic renal failure

Diseases such as diabetes mellitus, hypertension, chronic glomerulonephritis, uropathy and autoimmune diseases are considered the most frequent causes of renal failure. The aim of this study was to investigate oral manifestations caused by chronic renal failure. Oral manifestations of chronic renal failure include dysgeusia, stomatitis, decreased salivary flow rate, xerostomia and parotitis; moreover, dental oriented conditions include narrowing of pulp chamber, enamel abnormalities, tooth loss and periodontal disease. The most frequent dilemma in patients with Kidney failure is Renal Osteodystrophy. Chronic renal failure could be treated by renal replacement therapy, hemodialysis and peritoneal dialysis. These are methods of removing nitrogenous and other toxic byproducts of metabolized blood. Oral maladies due chronic renal failure occur because of immunosuppressive medications. However, this kind of therapy could be challenging as it causes gingival inflammation due to increased plaque deposition; which in turn affects the periodontal tissues. A good oral hygiene may reduce the risk of oral infections in chronic renal failure patients. The awareness about kidney related diseases is often neglected; however, the number of patients with oral manifestations related to chronic renal failure is miraculous

Trait impulsivity, alcohol intake and alcohol-related aggression

The objective of the study was to determine the association of trait impulsivity and alcohol related aggression among university students of Pakistan. The study design was a cross-sectional with a convenient sample of 209 university students, 47 females and 162 males, age group 17-26 with a mean age of M=21.95 years [SD=2.414] was obtained. AUDIT, HADS, BIS-11, BUS, TFLB and ARAQ scales were utilized to assess aggression, alcohol intake, and impulsivity in social drinkers. This study was conducted during the time period of January'2010 till December 2011. The data was analysed using SPSS 17. Cognitive dimension of impulsivity was statistically associated with alcohol related aggression. Alinear predictive capacity of alcohol consumption with aggression was also observed. The total score on the ARAQ scale was found to be significantly correlate with most of the variables at p<0.0005 with the exception of gender at p<0.01 and age, which was not found to significantly correlate with the ARAQ score. All four ARAQ subscales significantly correlated with all of the BIS and BP subscales at p<0.05. Gender was found to significantly correlate with the ARAQ total score [N=, r = 0.134, p<0.03 [one-tailed]]. Alcohol related aggression is associated with cognitive component of impulsivity among a representative sample of university students. An immediate need to identify and treat impulsivity among individuals consuming alcohol is imperative and may help to control harmful aggression

Pregnancy related periodontits and its complications

In females, during puberty, ovulation and pregnancy, there is an increase in the production of steroid sex hormones which lead to increased gingival inflammation, featured by gingival enlargement, increased gingival bleeding, increased crevicular fluid flow and microbial changes. Apart from gingivitits, in few cases patient do develop non. neoplastic gingival growth known as epulis. Steriod sex hormones have a significant effect on organ systems. As far as gingiva is concerned, they induce cellular proliferation, differentiation and keratinisation by raised keratinocyte and fibroblast activity. Estrogen is responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro organism found in the human mouth needs menadione [vitamin k] as essential growth factor and raised steroid sex hormones substitute it and promote bacterial growth. These microbial changes includes raised p. intermedia. Due to the microbial changes, PLBW [PRETERM LOW BIRTH WEIGHT] results as a complication. This condition is treated via non surgical method including scaling, polishing, root planing, patients counseling regarding nutrition, brushing habits, methods and duration

Relationship between periodontal disease, tooth loss and cancer

This review was undertaken to record the findings of various studies done on this topic in various countries

Oral health assessment and barriers to seek care in internally displaced persons from Bajaur agency, Pakistan

The aim of the study was to assess the oral health status of internally displaced persons from Bajaur Agency living in Jalozai Internally Displaced Persons camp, in Pakistan and to identify the barriers leading to unmet treatment needs. It was a descriptive analytical study, carried out at Jalozai Internally Displaced Persons camp. A total number of 400 individuals were studied. A WHO oral health assessment tool was modified and used while a separate questionnaire was developed to identify barriers to seek dental care. Oral mucosal infections were present in 31.8% of the studied population with oral ulcerations being the commonest. Prevalence of periodontal infections was 69%. The DMFT value for the population was 3.92%. Majority of the population relied upon self treatment. Financial reasons were considered by 74.2% of the subjects to be the most common barrier for unmet treatment needs. The high prevalence of caries, periodontal infections, oral mucosal infections as well as barriers to unmet oral health needs pose a significant threat to the overall health of the Internally Displaced Persons from Bajaur Agency

Effect of glycemic control on periodontal status

To assess the association between glycemic control and the periodontal status of an urban population with poor oral hygiene. Cross-sectional study. Memon Dental Care Centre and Memon Diabetic and Diagnostic Centre, Karachi, from July to December 2010. One hundred and forty-one individuals with controlled diabetes and 143 with uncontrolled diabetes were recruited from the dental clinic. All underwent clinical examination and grades on plaque index, gingival index, periodontal index and calculus index were recorded and compared. The group with uncontrolled diabetes included 56 males [38.9%] and 88 females [61.1%], and the controlled diabetic group included 49 males [34.8%] and 92 females [65.2%]. Periodontal index, gingival index and plaque index showed significant differences in both the groups [p-value < 0.016, < 0.001, < 0.002, respectively] while the difference of calculus was not significant i.e. 0.056. The mean number of teeth present in both the groups was 22. Most of the subjects cleaned their teeth once daily with the help of tooth brush, while the patients brushing twice daily were 16%. Uncontrolled diabetes had significantly severe impact on periodontal status in the studied groups with poor oral hygiene; diabetic patients have more number of missing teeth, and more plaque

Antibiotic prescription habits of swedish dentists

Antibiotic prescriptions have been on the increase worldwide, leading to increased antibiotic resistance. Inappropriate use of antibiotics has been blamed on lack of education and continuing professional development, and also on patient demand even when they are not required. This study was carried out to find out the pattern of prescriptions by Swedish dentists using data provided by pharmaceutical industry. The data shows that although the number of prescriptions is on the increase in Sweden, dentists still prefer to use conventional antibiotics such as Penicillin Vfor the treatment of oral diseases

Dental caries prevalence and risk factors among school children age12-15 years in Malir, Karachi

A cross sectional study to determine the prevalence of caries and risk factor among school children age!2-15 years was done in Malir Town, Karachi. Total sample size was 399 children from both boys and girls. Self-administered questionnaire and oral examination was carried out. There were 51% boys and 49% girls. The prevalence of dental caries was 66.67%.The mean DMFT score was 1.26. Mean DMFT was significantly higher in girls than boys. The carious lesions were more in girls than boys and were statistically significant. The dental caries increased as the age increased from 12 to 15 year

Halitosis

Halitosis is a broad term describing a range of unpleasant or offensive odours emitted in the breath, due to multiple causes.2 Volatile sulphur compounds may be the main source of oral malodor. The source may be oral or non-oral. Non-oral causes of bad breath are mostly related to systemic conditions and/or drugs prescribed by the physicians to treat medical conditions such as diabetes, liver disorder, kidney malfunctioning, pulmonary disease etc. Medications which reduce salivary flow like antipsychotics, narcotics, antidepressants, decongestants, antihistamines and antihypertensives may also be responsible.3 Oral causes of bad odor are mainly the gram-negative anaerobic bacteria, especially those localized at posterior surface of the tongue and within the surface of tongue and in throat. Oral malodours were drastically reduced after treating chronic periodontitis. Diagnosis can be confirmed by one of the 3 techniques which are; Organoleptic measurement, Gas Chromatography and Sulphide Monitoring. The treatment plan comprises elimination of the causative agent and improvement of the oral health status

Antibiotic prescription habits of dentists in major cities of Pakistan

The aim of this study was to describe the antibiotic prescription habits and trends of dentists of major cities of Pakistan. It was a descriptive study of antibiotic usage by dentists of 7 major cities of Pakistan, using data given by Aventis Pharmaceutical Company, Karachi, Pakistan. The data comprise of the total prescriptions, city wise, gender wise, patient wise and specialty wise breakup of sales of antibiotics. The data constituted dental antibiotics prescriptions which were given in percentage and numbers for all the different cities. The study showed that the antibiotic prescription has increased over the years from 2000 to 2008. Multan 318 to 415 / 1800 showed the most number of prescriptions. Penicillin was the main group prescribed. Most antibiotics were given for pulpal/periapical disease [343000 in 2008] to the age group 11-40 years old [65-70%from 2000-2008], and in general dental practice clinics [65-68%]. Antibiotic prescription habits of dentists vary in different cities of Pakistan. There is a need to develop guidelines to improve knowledge and to prevent antibiotic resistance